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survivorship

Fertility Rates in Childhood Cancer Survivors Suggest Strategies for Follow-up Care 

Childhood cancer survivors with clinical infertility have a good chance of achieving pregnancy, according to new findings from the Childhood Cancer Survivor Study (CCSS). Study Background As a group, women who survive childhood cancer are known to have lower fertility rates. This study, however,...

FDA Approves First Rapid Diagnostic Test to Detect Both HIV-1 Antigen and HIV-1/2 Antibodies

The U.S. Food and Drug Administration (FDA) approved the first rapid human immunodeficiency virus (HIV) test for the simultaneous detection of HIV-1 p24 antigen as well as antibodies to both HIV-1 and HIV-2 in human serum, plasma, and venous or fingerstick whole blood specimens. Approved for use as ...

lung cancer

Non–Small Cell Lung Cancer Maintenance Therapy: None, Single Agent, Multiple Agents? 

Barlesi et al have reported results of a randomized trial comparing bevacizumab (Avastin) vs pemetrexed (Alimta)/bevacizumab as maintenance therapy in patients with stage IV nonsquamous cell non–small cell lung cancer (NSCLC). It is important to consider their observations in relation to data from...

lung cancer

Pattern in Lung Cancer Pathology May Predict Recurrence After Surgery 

A new study by thoracic surgeons and pathologists at Memorial Sloan-Kettering Cancer Center shows that a specific pattern found in the tumor pathology of some lung cancer patients is a strong predictor of recurrence. Knowing that this feature exists in a tumor’s pathology could be an important...

lung cancer

Pemetrexed Maintenance in PARAMOUNT: Continuation Proves to Be a Strong Option for Advanced NSCLC, Although Not a Mandate 

The PARAMOUNT trial1 represents an important landmark study of continuation maintenance therapy with pemetrexed (Alimta). While maintenance therapy gained a toehold in routine management of advanced non–small cell lung cancer (NSCLC) several years ago, the first trials that demonstrated a...

lymphoma

Can Obinutuzumab Benefit Patients With Rituximab-Refractory Non-Hodgkin Lymphoma? 

Obinutuzumab is a glycoengineered type II antibody that differs from type I anti-CD20 antibodies by being associated with actin reorganization and adhesion followed by direct cell death.1 Obinutuzumab has been glycoengineered by reduction in fucose content of the Fc region, which increases its...

lymphoma

Molecular Profiling Improves Classification of Nodal Peripheral T-Cell Lymphomas 

One of the primary obstacles we face in caring for patients with peripheral T-cell lymphomas is a too often inadequate response to chemotherapy with low rates of progression-free and overall survival.1 And while more intensive treatment programs and the availability of novel agents give a greater...

skin cancer

Merkel Cell Carcinoma: Hints of Immune Mediation May Enhance Treatment Options 

Merkel cell carcinoma is a rare but aggressive skin cancer with poor outcomes and suboptimal therapeutic options. With a 46% mortality rate, it is three times more lethal than melanoma, and its reported incidence is rising. “Merkel cell carcinoma is a nasty cancer and we have zero FDA-approved...

gynecologic cancers

Olaparib Shows Robust Progression-Free Survival Benefit in Patients With BRCA Mutations 

Maintenance therapy with olaparib extended progression-free survival and the time to disease progression after a second subsequent therapy in patients with platinum-sensitive relapsed serous ovarian cancer and a BRCA mutation, according to an updated analysis of Study 19 presented at the 2013 ASCO...

lung cancer

Researchers Identify Gene Variations in Lung Cancer Patients That May Help Predict an Individual's Treatment Response

Researchers at the Moffitt Cancer Center have identified four inherited genetic variants in patients with non–small cell lung cancer that can help predict survival and treatment response. Their findings, published in Carcinogenesis,1 could help lead to more personalized treatment options and...

lung cancer

Paul A. Bunn, Jr, MD, Offers Insights About a Hopeful Era in Lung Cancer Treatment 

The treatment of non–small cell lung cancer (NSCLC) is rapidly evolving as molecular targets are being refined and targeted drugs are designed to combat acquired resistance. In his State of the Art Lecture at the 14th International Lung Cancer Congress, Dr. Bunn, Professor of Medicine and the James ...

lung cancer

Will Funding for Lung Cancer Ever Improve?

Lung cancer is the most common cause of cancer-related death in the world. In the United States alone, an estimated 228,190 new cases of lung cancer and 159,480 deaths from lung cancer will occur in 2013. These are alarming statistics when compared to the next four common causes of cancer-related...

issues in oncology

Access to and Appropriate Use of Oncology Drugs Called Into Question by ASCO Studies 

Studies presented at this year’s ASCO Annual Meeting suggest that despite the wealth of amazing oncolytics on the market, drug shortages persist, drug substitutions are common, off-label use of drugs occurs frequently, and patients find their costs burdensome. Drug Shortage Persists The shortage of ...

skin cancer

Addressing the Key Clinical Questions in Advanced Melanoma 

At the 3rd Annual World Cutaneous Malignancies Congress, in La Jolla, California, Steven J. O’Day, MD, Director of Clinical Research at the Beverly Hills Cancer Center and Adjunct Member of the John Wayne Cancer Institute, Los Angeles, addressed what he labeled the “key clinical questions” about...

leukemia

Cord Blood Transplantation Benefits Some Children With Juvenile Myelomonocytic Leukemia 

A retrospective analysis of 110 patients with juvenile myelomonocytic leukemia found that single-unit, unrelated donor umbilical cord blood transplantation resulted in a 5-year disease-free survival rate of 44%. “Our data document that a significant proportion of children with this disease,...

thyroid cancer

More Prudent Interpretation of Thyroid Ultrasound Could Reduce Unnecessary Biopsies 

Thyroid ultrasound imaging could be used to identify patients who have a low risk of thyroid cancer for whom biopsy could be deferred, according to a retrospective case-control study reported in JAMA Internal Medicine. Reviewing 11,618 thyroid ultrasound imaging examinations from 8,806 patients...

skin cancer

Indoor Tanning Common Among Young White Females Despite Skin Cancer Risk 

Indoor tanning, defined as using a tanning booth, sun bed, or sunlamp, is common among non-Hispanic white female high school students and young adults, despite risks of melanoma and nonmelanoma skin cancer, according to a study published online by JAMA Internal Medicine.  Using data from the 2011...

skin cancer

Low Risk of Transformation to Melanoma for Biopsy-Diagnosed Mildly or Moderately Dysplastic Nevi 

The risk of transformation to melanoma appears very low for biopsy-diagnosed mildly or moderately dysplastic nevi, and routine surgical excision of nevi with a positive biopsy margin may not be indicated. Patients with biopsy-diagnosed moderately-to-severely and severely atypical nevi, however,...

leukemia

FDA on CLL Drug Approval and Expanded Access

The ASCO Post article, “Ibrutinib CLL Trial: Where is the Equipoise?” published in May 2013, inaccurately conveyed that the Food and Drug Administration (FDA) requires an improvement in overall survival for chronic lymphocytic leukemia (CLL) drug approval and opposes allowing crossover in the...

leukemia

Pharmacyclics' Reply

We acknowledge the letters submitted to The ASCO Post from a patient advocate and a chronic lymphocytic leukemia (CLL) patient enrolled on the RESONATE study (PCYC-1112-CA). At Pharmacyclics, we are committed to adhering to high scientific and ethical standards as we strive to develop novel...

leukemia

Clinical Trials, Crossover, and Clinical Equipoise: An Advocate's Perspective

In a previous issue of The ASCO Post, Dr. Susan O’Brien wrote, “It is my understanding that the FDA strongly opposed allowing crossover [in the RESONATE trial]. I presume that is because the FDA also wants to see if there is a survival advantage.”1 The lack of crossover seems a valid concern to me...

leukemia

Clinical Trials, Crossover, and Clinical Equipoise: A Patient's Perspective

I am writing with regard to two articles on the ethical imperative of clinical equipoise written by Susan O’Brien, MD, and Stephen J. Schuster, MD, and published recently in The ASCO Post.1,2 I was a victim of Pharmacyclics’ policies during one of their randomized ibrutinib trials (PCI-32765)...

SIDEBAR: Expect Questions From Your Patients 

Physicians and patients should engage in open discussion” about the complex issues of cancer screening, overdiagnosis, and overtreatment, according to a report from the chairs of a National Cancer Institute working group tasked with developing a strategy to improve the current approach to cancer...

issues in oncology

Tackling Overdiagnosis and Overtreatment, by Words and by Deeds  

The complexity of the pathologic condition called cancer,” according to a Viewpoint article in the Journal of the American Medical Association,1 “complicates the goal of early diagnosis.” Failure to recognize that cancers are heterogeneous, and that not all progress to metastases and death, can...

Prominent Surgeon and Teacher LaSalle D. Leffall, Jr, MD, Promotes Hard Work and Education to Overcome Boundaries 

Reminiscing about his 65 years in medicine, LaSalle Doheny Leffall, Jr, MD, FACS, cites three events in his early childhood that would ultimately lead him to his position today as the Charles R. Drew Professor of Surgery at Howard University College of Medicine in Washington, DC. First, he was...

issues in oncology

The Oncologist as Author: On Guiding Patients Through Cancer 

When Tumor Is the Rumor and Cancer Is the Answer is the guidebook to cancer that Kevin P. Ryan, MD, FACP, COL, USAF (ret) wished his patients had during his 30 years of practicing oncology. The book, recently published by AuthorHouse, is an authoritative, inspiring, and even philosophical guide for ...

St. Jude Children's Research Hospital Recognizes Childhood Cancer Awareness Month

Childhood cancer remains the leading cause of death by disease among young Americans. September marks Childhood Cancer Awareness Month, a time to highlight efforts to reduce the disease’s toll on children. At St. Jude, the past year has brought advances in understanding and treating childhood...

survivorship

Cancer: Survivors in Focus Photo Exhibit Honors Cancer Survivors 

In June, the David J. Sencer Centers for Disease Control and Prevention (CDC) Museum in Atlanta, Georgia, opened a new photo exhibit featuring the faces of people living through and beyond a cancer diagnosis. The exhibit: Cancer: Survivors in Focus, tells the stories of cancer survivors while...

issues in oncology

The Direction of Immunotherapy Over the Next Decade 

The use of immunotherapy to target malignant cells in a variety of cancers—especially the PD-1 inhibitors lambrolizumab and nivolumab in the treatment of metastatic melanoma and the anti–PD-L1 agent MPDL3280A in the treatment of melanoma and lung, kidney, colorectal, and gastric cancers—made...

health-care policy
legislation

Sustainable Growth Rate Bill Advances in the House 

The U.S. House Energy and Commerce Committee has unanimously approved the Medicare Patient Access and Quality Improvement Act of 2013, which replaces Medicare’s sustainable growth rate formula. The law would provide 5 years of stable Medicare payments beginning in 2014, with reimbursement rates...

lymphoma

Potential Prognostic Significance Shown for Interaction of Follicular Lymphoma Cells with Immune Microenvironment 

It has been shown that CD4 and CD8 tumor-infiltrating lymphocytes in follicular lymphoma have impaired function and suppressed recruitment of critical signaling proteins to the immunologic synapse, and a number of studies have indicated the prognostic importance of the immune microenvironment in...

cns cancers

Sitimagene Ceradenovec/IV Ganciclovir in Glioblastoma: Legitimizing the Gene Therapy Approach for Brain Tumors 

The ASPECT study,1 a randomized, open-label, phase III trial examining adenovirus-mediated gene therapy with sitimagene ceradenovec followed by IV ganciclovir for patients with operable high-grade glioma, is an important achievement for both neuro-oncology and gene therapy. As vector engineering...

breast cancer

The BEATRICE Study: Where Does Targeting Breast Cancer Vasculature Stand in 2013? 

Antiangiogenic strategies using the anti–vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) gained traction in breast cancer with the publication of the Eastern Cooperative Oncology Group (ECOG) 2100 trial in 2007. That study demonstrated a progression-free survival ...

cns cancers

Resistance to Anti-VEGF Drugs in Glioblastoma Is Linked to Mesenchymal Transition 

Antiangiogenic therapy reduces tumor vascular permeability and delays tumor progression but may ultimately promote an aggressive treatment-resistant phenotype. In a study reported in Clinical Cancer Research, Piao and colleagues attempted to identify factors responsible for glioblastoma resistance...

gynecologic cancers

Timely Findings From the Ovarian Tumor Tissue Analysis Consortium 

In the Ovarian Tumor Tissue Analysis Consortium Study recently published by Sieh et al,1  tissue microarrays from 2,933 cases of epithelial ovarian carcinoma demonstrated that progesterone receptor (PR) expression and estrogen receptor (ER) expression were associated with significantly improved...

gynecologic cancers

Pretreatment Lymph Node Dissection May Improve Survival in Advanced Cervical Cancer, But for Too Few? 

Women with cervical cancer metastasized to para-aortic lymph nodes have historically had a poor prognosis, with 3-year overall survival rates of 25% to 40%.1-3 This has been attributed to the presence of occult systemic disease at the time of presentation and a high rate of distant recurrences...

breast cancer

Tamoxifen in Women With BRCA1 and BRCA2 Mutations: Another Option? 

In analyses of pooled information from cohorts of women with BRCA1 and BRCA2 mutations who have had a prior breast cancer diagnosis, Phillips and colleagues examined the association between tamoxifen use compared to nonuse on contralateral breast cancer risk.1 Tamoxifen use was associated with...

leukemia

Treatment of Relapse of Acute Leukemia Post-Transplant: Still Hope for Patients With Chemosensitive Disease 

Disease recurrence is a devastating event after allogeneic hematopoietic stem cell transplantation as treatment for acute myeloid leukemia (AML). Median time to relapse is approximately 4 months and the majority of relapses occur within 2 years after transplant. The prognosis is usually poor....

skin cancer

What Is the Optimal Treatment of Advanced Melanoma?  

With exciting targeted and immunotherapeutic agents now part of the arsenal for metastatic melanoma, which drug should move to the head of the line? Mario Sznol, MD, Professor of Medicine at Yale University School of Medicine, New Haven, Connecticut, has been involved in key clinical trials of the...

SIDEBAR: The Good, the Bad, and the Ugly 

Reviewing a study on off-label use of chemotherapy, Monika K. Krzyzanowska, MD, MPH, of Princess Margaret Cancer Centre University of Toronto, reflected on what she called the good, the bad, and the ugly of off-label drug use. “Certainly there are some good aspects about off-label therapy,” she...

issues in oncology

Prescribing of Off-Label Chemotherapy Is Common, and Most Off-Label Drug Use Meets NCCN Compendium Criteria  

Off-label prescribing of drugs remains common in oncology, but about two-thirds of off-label prescribing is consistent with the National Comprehensive Care Network (NCCN) compendium, according to a study1 reviewed at the Best of ASCO® ’13 meeting in Chicago by Monika K. Krzyzanowska, MD, MPH,...

Expert Point of View: Heather A. Wakelee, MD

Describing the PROSE study findings at the Best of ASCO meeting, Heather A. Wakelee, MD, Associate Professor of Medicine, Stanford University, Palo Alto, California, concluded, “The results of PROSE indicate that the 30% to 35% of patients classified as VeriStrat ‘poor’ have better survival with...

issues in oncology

A Great Privilege to Die Beneath an Open Sky 

It was 1:00 AM, and my beeping pager awakened me. When you’re a surgical oncologist, you know that a page from your chief resident at this hour of the morning usually means someone may need to go to the operating room. And, yes, it was the chief resident about a patient in crisis. Except in this...

breast cancer

Platinum Agents in Triple-Negative Breast Cancer: Encouraging New Data 

For the treatment of triple-negative breast cancer, there is renewed interest in investigating the role of platinum chemotherapy, according to Melinda L. Telli, MD, Assistant Professor of Medicine at Stanford University, Palo Alto. At the Best of ASCO meeting in Los Angeles, Dr. Telli reviewed the...

breast cancer

Platinum-Based Treatment of Triple-Negative Breast Cancer

The last issue of The ASCO Post reports encouraging results with platinum-based treatment of triple-negative breast cancer (September 15, 2013). We predicted these findings 4 years ago in a presentation at the 2009 Breast Symposium.1 We compared the activity of a series of agents (platinum, taxane, ...

To Die Beneath an Open Sky

I read the essay by Chandrakanth Are, MBBS, FRCS, FACS, published recently in The ASCO Post and found it both thoughtful and compelling (“A Great Privilege to Die Beneath an Open Sky,” The ASCO Post, September 15, 2013, page 1). Dr. Are made one statement with which I take exception, however, and...

'Doing Nothing' Is Not an Option

I applaud The ASCO Post for continuing to raise awareness about futile medical care at the close of life with the recent publication of a commentary by Dr. Chandrakanth Are (“A Great Privilege to Die Beneath an Open Sky,” The ASCO Post, September 15, 2013, page 1). I would suggest, however, that we ...

pancreatic cancer

High-Quality Diet May Reduce Risk 

Consuming a high-quality diet, consistent with the Dietary Guidelines for Americans 2005, may reduce the risk of pancreatic cancer, a dietary pattern analysis study found. “This finding contrasts with previous studies showing limited associations with specific foods or nutrients,” the authors...

prostate cancer

Shiftworkers Likely to Have Increased Risk  

A strong positive association with shiftwork and elevated prostate-specific antigen (PSA) level was found in an analysis of three National Health and Nutrition Examination Survey (NHANES) studies. “Our data support the notion that sleep or circadian disruption is associated with elevated PSA,...

breast cancer

Mindfulness-Based Stress Reduction Therapy for Patients With Distress 

Mindfulness-based cancer recovery was shown to be superior to supportive-expressive group therapy “for decreasing symptoms of stress and also for improving overall quality of life and social support” among women who had stage I to III breast cancer and were assessed as experiencing distress,...

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